When TV presenter Richard Hammond was involved in a serious car crash while filming for Top Gear in 2007, he spent two weeks in a coma and doctors gave him a slim chance of survival. 17 years later, in a video released on his social media, he talked about what he experienced while he was in that coma and how his wife helped to bring him back to consciousness.
So how much do people hear and feel when they are in a coma? Ger Curley is Professor of Anaesthesia and Critical Care at the Royal College of Surgeons and Consultant in Anaesthesia and Intensive Care in Beaumont Hospital. He joined RTÉ Radio 1's Today with Claire Byrne show to discuss what happens when you're in a coma. (This piece includes excerpts from the conversation which have been edited for length and clarity - you can hear the discussion in full above.)
Curley says the experience of coma differs from person to person; some people will remember some events around them while they're in a coma and and others don't. "Essentially a coma is a state of unconsciousness: A person is unresponsive and they cannot be woken. It arises because of a head injury most often, but also other conditions like stroke or a severe brain infection like meningitis."
"Someone in a coma, they're unconscious, they've minimal brain activity, they're alive but they cannot be woken up and they show no signs of awareness. But of course that occurs on a spectrum. So some patients will have some awareness of what is going on around them, especially when the voices of their loved ones are around. The tone of voice of somebody that they know, is something that is embedded in the brain very, very clearly," he explains.
A really important part of caring for coma patients is assessing where someone is on the spectrum of awareness and assessing their level of consciousness on a very regular basis, says Curley. "We assess whether they're able to open their eyes, whether they're able to move to command and whether they're able to speak to us. That forms part of something called the Glasgow coma scale score and it's a central part of of caring for these patients."
In the video, Richard Hammond talks about having a dream while he was in the coma, on full life support and on a breathing apparatus. When he woke, he told his wife about the dream and she explained that when doctors had said they thought Richard wouldn't survive, his wife had asked if she could shout at him. "Apparently she roared and screamed and swore at me 'don't you dare die' and that’s when I turned back from this tree in my dream and that’s when I woke," he explained in the video.
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From RTÉ Radio 1's Liveline, listeners talk to Katie Hannon about their coma experiences
Curley says: "It's a very common experience for patients that they have what we call delirium or they have hallucinations, they have dreams, they sometimes can hear voices that aren't there and then sometimes they can hear the voices of their their loved ones."
In the Beaumont intensive care unit, three in four patients will have a similar experience, Curley says. "We always tell relatives it's really important to to talk to patients when they come in, even if it appears that a patient is unresponsive. In particular for for relatives it is important because the sensation of the the voice, of touch, can help patients to return to consciousness. In fact, research has shown that relatives can assist in returning patients to more normal consciousness by speaking to them."
Brain injury occurs on a spectrum, says Curley. "So while on one end of the spectrum you can have a really profound brain injury and there is no possibility that a patient can hear or see, but in between wakefulness and a really severe injury, there are those zones where patients can potentially hear."
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From RTÉ Radio 1's The Ryan Tubridy Show, in 2019 Rosie Mangan was a passenger in a car involved in a serious accident which left her in an induced coma for a month
What is the brain doing during a coma?
The level of activity in the brain during coma depends on the of injury, says Curley. "For us all to be awake, for us all to be aware, we have to have these connections in our brain. So there's a connection between the area of the brain called the cerebral hemispheres, which is kind of at the top of the brain, and the area of the brain called the brain stem. So these connections are really important to maintain wakefulness. If there's injury to the brain there's a disconnection there, so there will be electrical activity going on and activity in regions of the brain, but there won't be the connections there.
There can be dreams, hallucinations, the sensation of pain or discomfort, but it's "just not all connected well," he explains. "Sometimes patients are just not able to perceive what the correct sound is, or are not able to respond to command. They can tell us afterwards that they heard us telling them to move their arm or move their leg, but they just weren't able to respond."
Returning to Richard Hammond, Claire asks if it's possible that he might have been "walking towards death" and he heard his wife's voice telling him not to do it and he made a choice? "I think that's it's unlikely," Curley says. "When patients are going to die from a brain injury, it's usually a very, very profound injury and there is usually no awareness at that time. But what is certainly true is that listening to the voices of loved ones can help us to to wake. I'm not sure that listening to the voice of loved ones would would be the difference between between dying and not dying in an intensive care unit."
